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V <br /> Please print or type.(Farm designed for use an ellie..(12-pitch)aypewriter.) _ Form Approved.AMB:Nb.2050-0035 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2'Page 101 3.EMargensy Response Phone 1:idan st Tracking Number <br /> WASTE MAN)FEST FLE <br /> 5.Generator's Name and Matting Address Generator's Site Address(11 different than malling address) <br /> Generator's Phone: n ori. yy s; <br /> 6.Transporterl Company Name U.S._EPA ID Number <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 8.Designated Fad€lily Name and Site Address U.S.EPA ID Number <br /> ,.t:�=-� <br /> Facilit}fs PnOna. <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, f 0,Contaiiners 11.Totat 12.Unit <br /> HM and Packing Group(d any)) 13.Waste Codas <br /> -- No. Type Llttan6ly..+-., W►Noi., <br /> '7_ <br /> g <br /> s,'s^:i a, ..?s.. �1a t.. . :��fa4.aiJ f4 `��&:1�' `. 5�`'Y.P .�t € }�a f"k;7 •g x!' 11 <br /> � _5 T <br /> 2 2. <br /> to , <br /> 0 <br /> 3, <br /> 4, <br /> 14,Special Handling Instructions and Additional Information <br /> } 1 >6rn f t c 0._rta I� 1':3 :;.? RAILCAR,Nt5 <br /> 15. GENERATOR'S(OFFEROMS CERTIFICATION:I hereby dedara that the contents of this consignment are fullyand sawrately described above by the proper shipping name;and are classified;packaged, <br /> marked and Iabeladlplacaraed;and are In all respects In proper condition for transport aaxirdirg to Wcacla Intemefboai and national governmental regulations.H export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment contain to the terms of the aitadled EPAA*owl*nwt of Consent. <br /> I certify that the waste minimization statement ider0ed In 40 CFR 26Z27(a)(If I am a large quantity generator)Df.(b),(If f am a small quantity generator)is he, <br /> Generatoty ro s PrintedlTyped Name signature <br /> on ay ear <br /> i Alr <br /> J 16.IntamaBort"la Shipments <br /> Import to U.S. El Export from U.S. Port of enfryle& <br /> — <br /> T <br /> i ransporter signature for ex_ oni : Date feavi "U,S.: <br /> w 17.Transporter AdmoMedgment of Receipt of Materials <br /> LLJ <br /> E— Transporter 1 Pdntedtfyped Name <br /> 0 '; ay ear <br /> . ..,.,, ,,7`. <br /> Transporter 2 PrintedlTyped Name Ignap re an y ear <br /> 18.Discrepancy <br /> 18e,Discrepancy Intl ation Space ❑ Quanfity <br /> El Two Residue ❑Partial Ra}ettion ❑Full R ,, <br /> Maai(est Rafemixe Number <br /> 18b.ARemato Fadfny(or Generator) U.S:EPA fD Number <br /> U <br /> Fablilys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) month Day Year <br /> 4 <br /> Z <br /> 19.Hazardous Waste Report Management fRatfxDd Codas(i.e.,.codes far hazardous vasta treats eiiij dtsp0sai,and rscyng sysistt s) <br /> � 1 <br /> =2. 3. 4: <br /> i <br /> Ll20.Designated Facility Owner or Operator;Certification of no*t of Hazardous materials.covered by the mart t exospyas note(!in Item 18a,�., <br /> PnnledrTyped Name <br /> 4 , Month Day Year <br /> EPA Form 8700.22(Rev,3.05) Previous editions are obsolete. t DESIGNATED FACILITY TQ GENERATOR. <br /> I <br />